The goal of the proposed AIDS malignancy research training program is to establish a team of Haitian physician scientists with expertise in the clinical epidemiology, HPV virology, and basic pathogenesis of AIDS related malignancies, with an emphasis on cervical cancer. Malignancy is the third leading cause of death in AIDS patients in Haiti, with a cancer death rate of 8 deaths per 1,000 patient years, despite the introduction of antiretroviral therapy (ART). Data suggest that fifty percent of the AIDS malignancy deaths are from cancer types related to HPV co-infection (oral, head, neck, cervical, and anal cancers). Cervical cancer is the most common cause of cancer death in women with AIDS receiving ART in Haiti. GHESKIO (the Haitian Group for the Study of Kaposi's Sarcoma and Opportunistic Infections) is a Haitian non-governmental organization dedicated to service, research, and training in HIV/AIDS and has collaborated with Cornell University since its inception in 1982. The Cornell-GHESKIO Fogarty training program will respond to the challenge of AIDS related malignancies by building on 26 years of established research capacity. A multidisciplinary group of established NIH funded researchers with common interests in HIV, HPV, and cancer oncogenesis will train Haitian physician scientists, clinicians, and laboratory personnel. Three Haitian physician-scientists will pursue a Masters of Science in clinical epidemiology at Cornell University and conduct their thesis research on AIDS related malignancies at the GHESKIO Centers in Haiti. Three clinicians and three laboratory personnel will also be trained to support the research of the physician trainees. Research-trainees will study AIDS malignancies in an established cohort of 800 HIV-infected patients in an ongoing NIH sponsored trial in Haiti. This randomized trial of early versus delayed ART aims to determine the optimal time to start therapy in HIV infected patients with a CD4 T cell count between 200 and 350 cells/ml. Research training will focus on three areas: 1) Trainees will prospectively determine the incidence of cancer in the cohort of 800 patients and determine the proportion of cancers that are related to high risk HPV co-infection. 2) Trainees will determine the effect of early antiretroviral therapy on the persistence of high-risk HPV infection of the cervix and on the diversity of HPV types in women enrolled in the trial. 3) Trainees will conduct translational studies on the role of prostaglandin E2 in the pathogenesis of HPV related cancers in HIV-infected hosts. [unreadable] [unreadable] [unreadable]